It concluded that the deal, hammered out between then prime minister Paul Martin and the premiers, produced few concrete results and certainly “didn’t lead to the major changes that were expected.”

All of this is sweet music to the ears of Prime Minister Stephen Harper. His government has already announced plans to dramatically cut back the money Ottawa gives the provinces for medicare.

Now Harper can argue, citing the accord’s critics, that his decision is justified — that spending more money on health care accomplishes nothing.

The real story of the accord, however, is more complicated.

True, it was far from an unalloyed success. It did not live up to Martin’s extravagant claim as a “fix for a generation.” Indeed, it was fatally flawed.

While it provided the provinces with billions of federal dollars to invest in areas such as home care or pharmacare, it contained no enforcement mechanism.

In the end, provinces could and did spend the money on whatever they wished, without financial penalty.

So it should come as no shock that the accord produced little transformative change. Doctors and hospitals remain the health system’s centrepiece, just as they were 10 years ago. Home care is patchy. There is still no national pharmacare program.

What surprises is that the accord accomplished as much as it did. For it did have successes.

Remember the context. In 2004, medicare was on the ropes. Federal government funding had been savagely cut back during the recession of the ’90s. Provinces too had been cutting. In Ontario, successive New Democratic and Conservative governments closed hospital beds and laid off nurses.

With public confidence in the health-care system foundering, opponents of medicare found a new audience for their old arguments. Alberta was flirting with the idea of private medicine. So was Quebec.

And part of the solution was financial. Yes, the system needed to be transformed. But it also needed cold, hard cash — to lure back the nurses who had gone to the U.S. seeking work, to operate diagnostic imaging machines more than a few hours a day, to reopen closed hospital beds.

In 2004, wait times for procedures such as cataract surgery or radiation therapy were far too long. Thanks to the accord, these wait times were significantly reduced.

The Canadian Institute for Health Information points out that today, roughly 80 per cent of patients in areas earmarked by the accord receive treatment within acceptable time limits. For cancer patients requiring radiation therapy, that figure is 90 per cent.

The Health Council of Canada report makes a convincing case that the accord was wanting. But it also quietly acknowledges that, over the decade, there were real gains.

Life expectancy for Canadians rose. Mortality rates for those with cancer and cardiovascular disease fell. Polls show that Canadians are more satisfied with medicare than they were in 2004.

As a percentage of economic output, Canada’s spending on health care has risen. But so has that of most other wealthy nations. France, Germany, the U.S, and the Netherlands all spend proportionally more

More to the point perhaps, we do not know how Canada’s health-care system would have fared had that $41 billion not been spent.

In short, the accord did more good than many, including me, ever predicted it would. Federal government money may not be sufficient to keep medicare healthy. But it is necessary. This is the real lesson of the health-care accord.

Thomas Walkom’s column appears Wednesday, Thursday and Saturday.

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